Evaluation of baseline fracture risk in younger postmenopausal women with breast cancer using different risk assessment methods

Dagmar Schaffler-Schaden,Bernhard Iglseder,Christian Pirich,Christoph Kneidinger,Maria Flamm,Gregor Schweighofer-Zwink

doi:10.1007/s00256-020-03378-z

Dagmar Schaffler-Schaden, Bernhard Iglseder + Show 4 more

Open Access

https://doi.org/10.1007/s00256-020-03378-z

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Abstract

ObjectiveControversy exists about the impact of bone mineral density (BMD) and fracture risk in newly diagnosed patients with breast cancer (BC). It is presumed that there are differences in BMD between women with BC and healthy controls. BMD is therefore considered as a potential marker to predict BC risk. This study was conducted to investigate the association of BMD, trabecular bone score (TBS) and fracture risk in younger postmenopausal women with hormone responsive BC.MethodsOverall, 343 women were examined. Women with BC were matched to a control group of the general population. Forty-nine women and fifty-nine controls were included in the final analysis. All subjects underwent dual energy x-ray absorptiometry (DXA) of the lumbar spine, femoral neck, and the total hip to evaluate bone mineral density. The 10-year fracture risk for a major osteoporotic fracture was assessed using the FRAX-score and the TBS-adjusted FRAX-Score, respectively.ResultsLumbar and femoral neck BMD were similar in BC patients and controls. No difference was found for TBS of the spine (1.38 ± 0.1 vs.1.36 ± 0.09) in the BC and the control group, respectively (p = 0.19). The 10- year probability for a major osteoporotic fracture (MoF) or femoral neck (FN) fracture was 6.1 (± 2.6%) and 0.9 (± 1.2%) in the BC group vs. 6.7 (± 3.5%) (p = 0.33) and 0.9 (± 1.1%) (p = 0.73) in the control group.ConclusionPostmenopausal women younger than 60 years with breast cancer do not show any differences in baseline BMD, TBS, or TBS adjusted FRAX in comparison to controls.

Highlights

The association of bone mineral density, fracture risk, and breast cancer is still unclear
Trabecular Bone Score (TBS) is obtained from lumbar spine dual energy x-ray absorptiometry (DXA) as an index to evaluate bone microarchitecture and enhances the accuracy of fracture risk assessment
TBS was identified as a predictor of fracture risk independently from bone mineral density (BMD), and, TBS in combination with FRAX (TBS-adjusted FRAX) can be used to refine fracture risk prediction of the FRAX tool [11, 12]

Summary

Results

Brozek et al reported that BMD was not found to be a predictor for BC in their study population of younger postmenopausal women [26] In another large sample of 13.698 patients, BMD in general was identified as a weak predictor of breast cancer. The main limitation is the small number of study participants enrolled The reason for this was that the study population included only women younger than 60 and breast cancer patients usually that are older. The main strength of the study is that it provides additional information about the fracture risk of younger postmenopausal women with the TBS adjusted FRAX tool and the comparison with an age-matched, population-based control group.

Introduction

Methods

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